Prevention Of Stomach Cancer Research Articles

Risk Factors and Prevention of Stomach Cancer, Excluding Helicobacter pylori

Gastric cancer is a significant health problem owing to its high incidence and mortality rate. The risk factors for gastric cancer include both uncontrollable (e.g., age, sex, and genetic predisposition) and controllable factors (e.g., <i>Helicobacter pylori</i> infection, smoking, alcohol consumption, obesity, and high-salt diets). Although treatment of <i>H. pylori</i> infections has been implemented as a primary preventive measure, the risk of gastric cancer may persist, highlighting the need for additional preventive measures. This review discusses various risks and protective factors associated with gastric cancer, studies conducted on these factors, and chemoprevention. Smoking is a risk factor for this disease; thus, is not recommended and current smokers are encouraged to quit because cessation can reduce the risk of gastric cancer. Excessive alcohol intake has been reported to increase the risk of gastric cancer as has the consumption of high-salt foods that can damage the gastric mucosa. Additionally, increasing the intake of fruits and vegetables, known for their protective effects against gastric cancer, can aid in its prevention. Studies on chemopreventive agents, including nonsteroidal anti-inflammatory drugs (e.g., aspirin), statins, and metformin, have been reported; however, evidence of their effectiveness remains insufficient to recommend these agents as preventive treatments. Additional well-planned studies on preventive medications and dietary approaches are necessary.

Estimating Taiwan's QALY league table for catastrophic illnesses: Providing real-world evidence to integrate prevention with treatment for resources allocation

Background/purposeCurative technologies improve patient's survival and/or quality of life but increase financial burdens. Effective prevention benefits all three. We summarize estimation methods and provide examples of how much money is spent per quality-adjusted life year (QALY) or life year (LY) on treating a catastrophic illness under a lifetime horizon and how many QALYs/LYs and lifetime medical costs (LMC) could be potentially saved by prevention. MethodsWe established cohorts by interlinkages of Taiwan's nation-wide databases including National Health Insurance. We developed methods to estimate lifetime survival functions, which were multiplied with the medical costs and/or quality of life and summed up to estimate LMC, quality-adjusted life expectancy (QALE) and lifetime average cost per QALY/LY for catastrophic illnesses. By comparing with the age-, sex-, and calendar year-matched referents simulated from vital statistics, we obtained the loss-of-QALE and loss-of-life expectancy (LE). ResultsThe lifetime cost-effectiveness ratios of ventilator-dependent comatose patients, dialysis, spinal cord injury, major trauma, and cancers were US$ 96,800, 16,200–20,000, 5500–5,900, 3400–3,600, and 2900–11,900 per QALY or LY, respectively. The successful prevention of lung, liver, oral, esophagus, stomach, nasopharynx, or ovary cancer would potentially save US$ 28,000–97,000 and > 10 QALYs; whereas those for end-stage kidney disease, stroke, spinal injury, or major trauma would be US$ 55,000–300,000 and 10–14 QALYs. Loss-of-QALE and loss-of-LE were less confounded indicators for comparing the lifetime health benefits of different technologies estimated from real-world data. ConclusionsIntegration of prevention with treatment for resources allocation seems feasible and would improve equity and efficiency.

The prevalence and risk factors of Helicobacter pylori infection and cagA virulence gene carriage in adults in the Navajo Nation.

American Indian and Alaska Native people in the United States experience high rates of stomach cancer. Helicobacter pylori infection is a significant risk factor for stomach cancer, and H. pylori strains that carry the cagA gene are linked to greater gastrointestinal disease severity. Yet, little is known about H. pylori and cagA infections in American Indian and Alaska Native people, particularly at the tribal level. We assessed the prevalence and risk factors of H. pylori infection and cagA gene carriage in tribal members from the Navajo Nation. We conducted a cross-sectional study with adults from the Navajo Nation. Stool samples collected from participants were analyzed with droplet digital PCR for H. pylori 16S ribosomal and cagA virulence genes. Self-administered health and food questionnaires were mailed to participants to collect information on sociodemographic, health, lifestyle, and environmental risk factors for H. pylori infection. Logistic regression assessed the association between risk factors and H. pylori infection and cagA gene carriage. Among 99 adults, the median age was 45 (age range: 18 to 79 years), and 73.7% were female. About 56.6% (95% CI: 46.2-66.5) of participants were infected with H. pylori. Of H. pylori-infected participants, 78.6% (95% CI: 65.6-88.4) were cagA-gene positive. No significant associations of relevant risk factors with H. pylori and cagA-gene positive infections were noted. In a community-based study population, a substantial proportion of adult tribal members had H. pylori and cagA-gene positive infections. Given these high proportions, culturally appropriate prevention strategies and interventions addressing H. pylori infections present an avenue for additional research and stomach cancer prevention in the Navajo Nation.

Abstract C105: Addressing stomach cancer disparities in low-income New York City Chinese American immigrants: A randomized controlled trial

Abstract Background Stomach cancer is the most common infection-related cancer worldwide. In the United States, Chinese Americans, especially recent immigrants, experience a disproportionate burden of stomach cancer incidence and mortality. Infection with the bacterium Helicobacter pylori (H. Pylori) is the strongest risk factor for stomach cancer. However, adherence to the complex H. pylori treatment regimen is challenging for Chinese New Yorkers with limited English proficiency (LEP) and low health literacy. By linking bilingual/bicultural community health workers (CHWs) to Chinese-speaking patients in clinical settings – the first intervention of its kind that targets this at-risk population – we aim to help participants facilitate H. pylori eradication and stomach cancer prevention. Objective We seek to implement and assess the efficacy of a patient-centered, culturally-adapted and in-language intervention to reduce stomach cancer risk factors for at-risk Chinese American immigrants in NYC. Methods We conducted a multiyear, 2-arm RCT (n=135). Participants randomized to the intervention group were paired with a bilingual/bicultural CHW for 6 months and received a standardized protocol consisting of culturally and linguistically-adapted educational sessions, goal-setting and action planning. Data collection methods include: 1) Baseline, 2-month and 6-month surveys; 2) interviews with intervention group participants; and 3) encounter reports. Clinical outcomes were confirmed through chart review. Results Participants in the RCT were predominantly LEP, low-income Chinese immigrants with low health literacy and limited knowledge of H. pylori and stomach cancer risk factors. We will share the primary and secondary study outcomes of H. pylori eradication, medication adherence, self-efficacy, and health literacy. Our results will be supplemented with qualitative findings from the encounter reports detailing participant barriers and facilitators to medication adherence, goal-setting and behavior change. Citation Format: Simona Kwon, Yi-Ling Tan, Suzanne Vang, Angel Mui, Janet Pan, Stella Chong, Laura Wyatt, Qiuqu Zhao, Renee Williams, Patrick Xiao, Anju Malieckal, Zoi Gamagaris, Chau Trinh-Shevrin. Addressing stomach cancer disparities in low-income New York City Chinese American immigrants: A randomized controlled trial [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C105.

Abstract B026: Barriers and facilitators to Helicobacter pylori screening and treatment to prevent stomach cancer among Chinese, Korean, and Vietnamese American communities

Abstract Purpose: The purpose of this study is to evaluate Chinese, Korean, and Vietnamese (CKV) community members’ knowledge, practices, barriers, and facilitators regarding Helicobacter pylori (H. pylori) testing and treatment. CKV persons in the United States (US), especially those who are foreign-born, have higher prevalence of H. pylori infection, which contributes to relatively high rates of stomach cancer. This pilot study aimed to inform a future intervention that would test for and treat H. pylori among at-risk CKV communities as a means of early stomach cancer prevention. Methods: Researchers conducted a survey and 15 focus groups for a total of n=90 voluntary participants (n=29 for Chinese, n=30 for Korean, and n=31 for Vietnamese) living in the southern California region. The survey and focus groups were conducted both online and in-person in Mandarin, Korean, and Vietnamese languages. The survey included demographic and socioeconomic questions, as well as measures of participant knowledge, attitudes, and beliefs about H. pylori infection, prevention, and treatment. The focus group guide was informed by the Health Belief Model to evaluate participants’ perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action for H. pylori testing and treatment. Results: CKV participants varied in their level of knowledge about H. pylori, but most expressed little awareness of H. pylori and the associated risks. Focus groups revealed that community members were mostly unaware of high susceptibility to H. pylori among CKV people. Nevertheless, CKV community members believed that H. pylori and stomach cancer to be serious health issues. Most CKV community members cited lack of awareness as a major barrier to getting tested for H. pylori. However, groups differed in their opinions on barriers to treatment. While Chinese and Korean groups mostly agreed that a physicians’ diagnosis and recommendation would facilitate completing the H. pylori treatment regimen for their communities, Vietnamese groups noted greater levels of medical. Vietnamese groups expressed some uncertainty about antibiotics and medications that would cause potentially harmful side-effects. To various extents, CKV groups noted that increasing awareness about H. pylori through community-based initiatives utilizing sources of trusted information, respected community leaders, and online and in-person social networks would be effective strategies for increasing testing and treatment. Conclusion: Community-based initiatives to increase H. pylori testing and treatment may be useful for stomach cancer prevention among at-risk CKV populations. This study provides needed insights into what types of content these initiatives might include and how to provide information in a way that is culturally relevant to the needs of CKV communities. There are different barriers and facilitators to testing and treatment for H. pylori among CKV community members. Interventionists must keep these nuances in mind and tailor their approaches appropriately. Citation Format: Brittany N. Morey, Grace E. Lee, Tin Q. Tran, Derek Chang, Julienne Lee, Nancy Mai, Sanga Min, Tami C. Nguyen, Hye Won Park, Qin Wang, Sunmin Lee. Barriers and facilitators to Helicobacter pylori screening and treatment to prevent stomach cancer among Chinese, Korean, and Vietnamese American communities [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B026.

Stomach Cancer Screening Services of Bhutan.

Stomach cancer is a common public health problem in South East Asia including Bhutan. Chronic infection with Helicobacter pylori is regarded as the principal cause of stomach cancer. Herein, we present the incidence of stomach cancer in Bhutan for eight years (from 2014 to 2021). We also discuss the steps taken for the prevention and early detection of stomach cancer.

Topical issues of prevention of stomach cancer: A review

Prevention of gastric cancer, both primary and secondary, is an extremely important component of the management of gastroenterological patients. The correct collection of anamnesis with an assessment of the hereditary (family) cancer risk, the action of risk factors (eating disorders, habitual/chronic intoxication, obesity, Helicobacter pylori infection, etc.), as well as the use of gastroprotectors (in particular, the drug Regastim Gastro), especially in persons with potentially precancerous the condition is chronic atrophic gastritis. According to the data of a double-blind placebo-controlled randomized study Regastim Gastro (active ingredient alpha-glutamyl tryptophan) in the treatment of chronic atrophic gastritis, it was found that this drug has a powerful anti-inflammatory effect and regenerative activity. Taking the drug Regastim Gastro, compared with placebo, statistically significantly contributed to a decrease in the number of inflammatory infiltration cells per 1 mm2 of the gastric mucosa. Regastim Gastro decreases in eosinophilic (3 times) and neutrophilic (4 times) infiltration of the gastric mucosa and also reduced the number of macrophages, lymphocytes and plasmocytes. In addition to anti-inflammatory properties, the drug also had a pronounced regenerative effect. Taking of Regastim Gastro statistically significant (p=0.028) increases in the number of glands per 1 mm2 of the gastric mucosa by 26.1% compared with the initial screening indicators. In the group of patients taking placebo, on the contrary, there was a further progression of the pathological process, accompanied by a decrease in the number of glands per 1 mm2 of the gastric mucosa after the end of treatment in comparison with the initial indicators. After the course of therapy, the number of glands per 1 mm2 of the gastric mucosa in patients taking the drug Regastim Gastro was statistically significantly higher in comparison with the results in the placebo group (p=0.013). After the course of Regastim Gastro, there was an improvement in acid production: a shift in the acidic side of the average pH value (1.6 times) and an increase in the value of the acidity index, both when compared with the initial values (5.4 times) and in comparison with the placebo group (2.9 times). The intake of Regastim Gastro to patients with gastritis, both H. pylori (+) and H. pylori (-) before the development of atrophy of the gastric mucosa can reduce the inflammatory factor, prevent the occurrence of atrophy and may have maximum anti-carcinogenic action.

Prevention of gastrointestinal cancer

Throughout the past decades, considerable progress has been made in the (early) diagnosis and treatment of gastrointestinal cancers. However, the prognosis for advanced stages of gastrointestinal tumors remains limited for many patients and approximately one third of all tumor patients die as a result of gastrointestinal tumors. The prevention and early detection of gastrointestinal tumors is therefore of great importance.For this reason, we summarize the current state of knowledge and recommendations for the primary, secondary and tertiary prevention of esophageal, stomach, pancreas, liver and colorectal cancer in the following.

The importance of community and culture for the recruitment, engagement, and retention of Chinese American immigrants in health interventions.

Chinese Americans experience cancer health disparities throughout the entire cancer continuum. Yet, they remain underrepresented in health research in part due to barriers in recruitment, engagement, and retention. This paper describes the strategies that we devised, by drawing upon our experiences with conducting two culturally sensitive cancer intervention studies, to help researchers improve their recruitment and retention rates of Chinese Americans in health research and address the gap in knowledge on intervention research with this population. The first study assessed the efficacy, adoption, and impact of an intervention, delivered by community health workers, to improve adherence to recommended stomach cancer prevention guidelines for at-risk Chinese Americans. The second study evaluated the feasibility and preliminary efficacy of a culturally adapted version of the Expressive Helping intervention for Chinese American cancer patients and survivors. Our main recruitment strategies revolved around building community relationships, developing culturally sensitive materials, and establishing good first impressions with participants. Our main engagement and retention strategies focused on attending to cultural sensitivity, fostering relationships, and using technology. Harnessing the community's inherent strengths and prioritizing cultural understanding is crucial for culturally sensitive health research with Chinese Americans.

Abstract PO-025: The Durham Initiative for Stomach Health (DISH): A pilot community-based Helicobacter pylori education and screening study

Abstract Background: Approximately 15% of all cancers are due to infection. The bacteria Helicobacter pylori is the single leading carcinogenic infectious agent and the main cause of stomach cancer. Prevalence of H. pylori, and, correspondingly, stomach cancer incidence and mortality, is significantly greater among African Americans than whites in the United States. In the present study, we conducted a pilot community- engaged H. pylori education and screening study in partnership with a predominantly African American church in Durham, North Carolina. Methods: Initially, we consulted with community advisory boards and convened stakeholder meetings with local community members and primary care physicians. We then developed this pilot study through an iterative collaboration with church partners. Our main outcomes were feasibility and acceptability as measured by participation in a one-day H. pylori screening initiative, and participation in follow-up for those who tested positive. We also sought to determine prevalence and determinants of active H. pylori infection in this population. Results: Community engagement informed the event logistics, messaging, educational materials provided, and follow-up plans. A total of 92 individuals participated in the primary study event, 25% of whom had a current H. pylori infection. Of those, 87% returned for the follow-up events, among whom 70% had successfully cleared their infection. Conclusions: Through community engagement, community-based H. pylori screening and stomach cancer prevention is feasible and acceptable. This is a necessary step in order to move stomach cancer prevention forward to population-based precision H. pylori screening and eradication. Citation Format: Sydnee Crankshaw, Julia Butt, Jennifer Gierisch, Nadine Barrett, Sabrena Mervin-Blake, Kevin Oeffinger, Steven Patierno, Valarie Worthy, Ronald Godbee, Meira Epplein. The Durham Initiative for Stomach Health (DISH): A pilot community-based Helicobacter pylori education and screening study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-025.

The Potential Anticancer Activity of Phytoconstituents against Gastric Cancer-A Review on In Vitro, In Vivo, and Clinical Studies.

Gastric cancer belongs to the heterogeneous malignancies and, according to the World Health Organization, it is the fifth most commonly diagnosed cancer in men. The aim of this review is to provide an overview on the role of natural products of plant origin in the therapy of gastric cancer and to present the potentially active metabolites which can be used in the natural therapeutical strategies as the support to the conventional treatment. Many of the naturally spread secondary metabolites have been proved to exhibit chemopreventive properties when tested on the cell lines or in vivo. This manuscript aims to discuss the pharmacological significance of both the total extracts and the single isolated metabolites in the stomach cancer prevention and to focus on their mechanisms of action. A wide variety of plant-derived anticancer metabolites from different groups presented in the manuscript that include polyphenols, terpenes, alkaloids, or sulphur-containing compounds, underlines the multidirectional nature of natural products.

The Durham Initiative for Stomach Health (DISH): a pilot community-based Helicobacter pylori education and screening study

BackgroundApproximately 15% of all cancers are due to infection. The bacteria Helicobacter pylori is the single leading carcinogenic infectious agent and the main cause of stomach cancer. Prevalence of H. pylori, and, correspondingly, stomach cancer incidence and mortality, is significantly greater among African Americans than whites in the United States. In the present study, we conducted a pilot community-engaged H. pylori education and screening study in partnership with a predominantly African American church in Durham, North Carolina.MethodsInitially, we consulted with community advisory boards and convened stakeholder meetings with local community members and primary care physicians. We then developed this pilot study through an iterative collaboration with church partners. Our main outcomes were feasibility and acceptability as measured by participation in a one-day H. pylori screening initiative, and participation in follow-up for those who tested positive. We also sought to determine prevalence and determinants of active H. pylori infection in this population.ResultsCommunity engagement informed the event logistics, messaging, educational materials provided, and follow-up plans. A total of 92 individuals participated in the primary study event, 25% of whom had a current H. pylori infection. Of those, 87% returned for the follow-up events, among whom 70% had successfully cleared their infection.ConclusionsThrough community engagement, community-based H. pylori screening and stomach cancer prevention is feasible and acceptable. This is a necessary step in order to move stomach cancer prevention forward to population-based precision H. pylori screening and eradication.

Beneficial Properties of Green Tea Catechins.

Green tea (Camellia sinesis) is widely known for its anticancer and anti-inflammatory properties. Among the biologically active compounds contained in Camellia sinesis, the main antioxidant agents are catechins. Recent scientific research indicates that the number of hydroxyl groups and the presence of characteristic structural groups have a major impact on the antioxidant activity of catechins. The best source of these compounds is unfermented green tea. Depending on the type and origin of green tea leaves, their antioxidant properties may be uneven. Catechins exhibit the strong property of neutralizing reactive oxygen and nitrogen species. The group of green tea catechin derivatives includes: epicatechin, epigallocatechin, epicatechin gallate and epigallocatechin gallate. The last of these presents the most potent anti-inflammatory and anticancer potential. Notably, green tea catechins are widely described to be efficient in the prevention of lung cancer, breast cancer, esophageal cancer, stomach cancer, liver cancer and prostate cancer. The current review aims to summarize the potential anticancer effects and molecular signaling pathways of major green tea catechins. It needs to be clearly emphasized that green tea as well as green tea catechols cannot replace the standard chemotherapy. Nonetheless, their beneficial effects may support the standard anticancer approach.

Risk factors for stomach cancer: a systematic review and meta-analysis

OBJECTIVESThis report provides information on 14 behavioral and nutritional factors that can be addressed in stomach cancer prevention programs.METHODSPubMed, Web of Science, and Scopus were searched through December 2018. Reference lists were also screened. Observational studies addressing the associations between stomach cancer and behavioral factors were analyzed. Between-study heterogeneity was investigated using the χ2, τ2, and I2 statistics. The likelihood of publication bias was explored using the Begg and Egger tests and trim-and-fill analysis. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model.RESULTSOf 52,916 identified studies, 232 (including 33,831,063 participants) were eligible. The OR (95% CI) of factors associated with stomach cancer were as follows: Helicobacter pylori infection, 2.56 (95% CI, 2.18 to 3.00); current smoking, 1.61 (95% CI, 1.49 to 1.75); former smoking 1.43 (95% CI, 1.29 to 1.59); current drinking, 1.19 (95% CI, 1.10 to 1.29); former drinking, 1.73 (95% CI, 1.17 to 2.56); overweight/obesity, 0.89 (95% CI, 0.74 to 1.08); sufficient physical activity, 0.83 (95% CI, 0.68 to 1.02); consumption of fruits ≥3 times/wk, 0.48 (95% CI, 0.37 to 0.63); consumption of vegetables ≥3 times/wk, 0.62 (95% CI, 0.49 to 0.79); eating pickled vegetables, 1.28 (95% CI, 1.09 to 1.51); drinking black tea, 1.00 (95% CI, 0.84 to 1.20); drinking green tea, 0.88 (95% CI, 0.80 to 0.97); drinking coffee, 0.99 (95% CI, 0.88 to 1.11); eating fish ≥1 time/wk 0.79 (95% CI, 0.61 to 1.03); eating red meat ≥4 times/wk 1.31 (95% CI, 0.87 to 1.96), and high salt intake 3.78 (95% CI, 1.74 to 5.44) and 1.34 (95% CI, 0.88 to 2.03), based on two different studies.CONCLUSIONSThis meta-analysis provided a clear picture of the behavioral and nutritional factors associated with the development of stomach cancer. These results may be utilized for ranking and prioritizing preventable risk factors to implement effective prevention programs.

Современные аспекты профилактики рака желудка

Objective of the Review: to analyse available data on stomach cancer prevention. Key Points. Key risk factors for stomach cancer are male gender, age of >50 years old, Helicobacter pylori and smoking. A number of international consensus opinions regulate screening, diagnostics and treatment of precancer changes in stomach; it is assumed to reduce the incidence of this disease. H. pylori eradication is the key method of primary stomach cancer prevention. Modern studies demonstrate that the optimal method of H. pylori eradication is the therapy with bismuth medication, proton pump inhibitor, amoxycillin and clarithromycin for 10–14 days. Conclusion. The most efficient method of stomach cancer prevention is H. pylori eradication, smoking cessation, diet with plenty of vegetables and fruit. Secondary prevention is optimisation of diagnostics, follow-up and treatment of precancer stomach conditions. Keywords: stomach cancer, gastratrophia, Helicobacter pylori, prevention.

Dietary Intake of Fatty Acids, Total Cholesterol, and Stomach Cancer in a Chinese Population.

To investigate the associations between dietary fatty acids and cholesterol consumption and stomach cancer (SC), we analyzed data from a population-based case-control study with a total of 1900 SC cases and 6532 controls. Dietary data and other risk or protective factors were collected by face-to-face interviews in Jiangsu Province, China, from 2003 to 2010. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple unconditional logistic regression models and an energy-adjusted method. The joint associations between dietary factors and known risk factors on SC were examined. We observed positive associations between dietary saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), and total cholesterol and the development of SC, comparing the highest versus lowest quarters. Increased intakes of dietary SFAs (p-trend = 0.005; aOR, 1.11; 95% CI, 1.01–1.22 with a 7 g/day increase as a continuous variable) and total cholesterol (p-trend < 0.001; aOR, 1.13; 95% CI, 1.06–1.22 with a 250 mg/day increase as a continuous variable) were monotonically associated with elevated odds of developing SC. Our results indicate that dietary SFAs, MUFAs, and total cholesterol are associated with stomach cancer, which might provide a potential dietary intervention for stomach cancer prevention.

New European guidelines for the management of patients with precancerous changes in the stomach

Aim of the review: to analyze the current aspects of the management of patients with precancerous changes in the stomach, as outlined in the new MAPS II European recommendations.Basic provisions. For qualified diagnosis of precancerous changes in the stomach it is necessary to use modern endoscopic and morphological methods. Timely detection of atrophy, metaplasia and dysplasia significantly increases the effectiveness of gastric cancer prevention. Eradication of Helicobacter pylori infection is an important principle in the management of patients with precancerous changes in the stomach.Conclusion. According to European recommendations, timely diagnosis, adequate treatment and follow-up of patients with precancerous gastric changes play an important role in the prevention of stomach cancer. The application of such principles in daily clinical practice will allow standardization of the approach to the management of patients with pre-tumor pathology.

DYNAMICS OF MORBIDITY AND MORTALITY FROM MALIGNANT TUMORS IN RUSSIA

The article presents an analysis of the dynamics of the incidence of malignant tumors (MT) and mortality from them. An attempt has been made to analyze the causes of the growth or decrease in morbidity and mortality from some forms of MT. Based on the analysis of domestic and international experience suggestions on planning measures to further reduce MT mortality and morbidity in the Russian Federation were made. Mortality from MT in Russia reduces mainly by decreasing of mortality from lung cancer and other forms of cancer, the cause of which is smoking, as well as from stomach cancer. Primary prevention plays a dominant role in this decline. Reducing death rates from MT alone saved the lives of at least 300 000 Russians as well as many tens of thousands of citizens of other countries of the former USSR, in which the mortality from this disease also decreased. The observed increase in MT incidence is the result of an increase in the prevalence in the population of risk factors for a number of MT. However an important role in this growth is played by the use for early diagnosis of modern highly sensitive technologies that “reveal” clinically insignificant tumors that were not previously found in clinical practice. To further reduce death rates from MT it is necessary to expand the range of preventive measures. We need a program to vaccinate adolescents against human papillomavirus (HPV). The vaccinated generation will be cured of cervical cancer and this is one of the most common forms of cancer among women. In the next 2-3 decades it is necessary to conduct regular organized screening to detect HPV infection. A serious revision of our position on screening will allow reducing mortality from cancer of the cervix, colon and rectum and, possibly, the breast. It is necessary to introduce methods of so-called drug prevention. A convincing evidences of the effectiveness of taking aspirin for the prevention of colon and stomach cancer, tamoxifen - for the prevention of breast cancer. The future of early diagnosis is of tumor markers. It is necessary to test in the population the effectiveness of determining tumor markers, for example, circulating free tumor DNA and mRNA for early detection of cancer. Of course this does not mean that we must give up measures aimed at limiting smoking and promoting healthy lifestyles. Reducing alcohol consumption, changing the type of food to reduce consumption of processed meat products and meat and increasing consumption of fish, vegetables and fruits as well as increasing physical activity will undoubtedly lead to a reduction in morbidity and mortality from many basic forms of MT.

Роль препаратов висмута в повышении эффективности эрадикации инфекции Helicobacter pylori

Aim of review. To demonstrate modern potential of bismuth agents administration for increasing of Helicobacter pylori (H. pylori) eradication efficacy. Summary. Prevention of peptic ulcer and stomach cancer makes eradication of H. pylori infection more and more important. At the same time efficacy of some eradication modes, first of all - that of standard triple therapy, steadily decreases because of growing antibiotic resistance of H. pylori strains, first of all - clarithromycin resistance. The concept that empirical prescription of standard triple therapy should be abandoned in favor of initial H. pylori clarithromycin-resistance testing by culture or real-time polymerase chain reaction became widely accepted. Bismuth-based quadrotherapy mainly - with bismuth tripotassium dicitrate (BTD) is alternative to standard triple mode therapy nowadays. Potential of BTD combination not only to tetracycline but to other antibiotics as well was demonstrated. Addition of BTD to triple therapy containing clarithromycin, levofloxacin, metronidazole allows to increase eradication efficacy for 30-40% at H. pylori-resistant strains. Absence of H. pylori resistance development to BTD, combined antibacterial and cytoprotective effects as well as good tolerance are important advantages of the drug. Conclusion. Addition of BTD to triple H. pylori eradication modes, that include different antibiotics (clarithromycin, levofloxacin and metronidazole) provide significant increase in efficacy of eradication at antibioticresistant Helicobacter pylori strains.

Клинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению инфекции Helicobacter pylori

Aim of publication. To present indications for antihelicobacter therapy, methods and sequence of diagnostics and eradication treatment of Helicobacter pylori (H. pylori) infection to general practitioners. Key points. Chronic gastritis caused by H. pylori infection, including that in «asymptomatic» patients can be considered to be an indication for H. pylori eradication therapy both as etiological treatment and opportunistic screening diagnostics for gastric cancer prevention. Indications for obligatory antihelicobacter therapy include stomach and a duodenum peptic ulcer (PU), stomach MALT-lymphoma, early gastric cancer with endoscopic resection. Breath test with 13С-labeled urea, laboratory test for assessment of anti-H. pylori antibodies in feces, rapid urease test and serological method can be recommended for primary diagnostics of infection. Serological test is not applicable after antihelicobacter therapy. According to the bulk of regional studies clarithromycin resistance level of H. pylori strains in Russia does not exceed 15%. Obtained data indicate the absence of high metronidazole-resistance of H. pylori as well as double resistance to clarithromycin and metronidazole. Standard triple therapy including proton pump inhibitor (PPI), clarithromycin and amoxicillin is recommended as first-line treatment for H. pylori eradication. Standard triple therapy should be carried out, applying various means that increase its efficacy. Alternatively to standard triple therapy, first-line eradication treatment may include four-component bismuth tripotassium dicitratebased therapy or non-bismuth quadrotherapy which includes PPI, amoxicillin, clarithromycin and metronidazole. Quadrotherapy with bismuth tripotassium dicitrate can also be applied as a basic mode of the second line treatment at inefficiency of standard triple therapy. Alternative mode of second line eradication treatment includes PPI, levofloxacin and amoxicillin. Levofloxacinbased triple therapy prescription in the presence of strict indications should be limited to gastroenterologists. The third-line eradication treatment is adjusted individually according to the history of previous treatment modes. Eradication efficacy may be increased by prolongation of treatment up to 14 days, applicaiton of modern PPIs or increase of PPI doze, addition of bismuth tripotassium dicitrate or probiotic. Conclusion. In each case of H. pylori detection it is reasonable to consider eradication therapy that is especially actual as H. pylori infection eradication is recognized as effective method of stomach cancer prevention. H. pylori eradication optimization methods can be applied both to standard and alternative modes while combination of these approaches allows to achieve the best result in a given patient.